First Web Space Postburn Scar Contractures: Anatomy and Elimination with Local Trapezoid Flaps

Abstract

First web space contractures commonly occur in dorsal, palmar, and total hand burns, and can have a significant impact on overall hand function because thumb abduction and opposition are either impaired or lost. The functional deficiencies include loss of grasp and loss of key pinch. When a first web space adduction contracture occurs, it justifies surgical intervention. Despite the abundance of surgical methods, the problem of reconstruction of the first web space has not been resolved. No comparative studies have reviewed the effectiveness of various methods of reconstruction, so there has been no clear understanding of what surgical method to choose under any given conditions. Based on personal clinical observations, the three basic anatomical types of thumb adduction contractures were identified, and the methods of reconstruction for each type were developed. With the use of these plasty methods, all web space scar contractures can be eliminated completely and definitively.